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NPI Code Detail

MEDICARE: LABORATORIO CLINICO ESMERALDA INC

MEDICARE: LABORATORIO CLINICO ESMERALDA INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1291U00000XClinical Medical Laboratory386PR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
130332OTHERPRSSS PROVIDER NUMBER

General Provider Information

NPI Number : 1457330144
Entity Type Code : Organization
Provider Name (Legal Business Name) : LABORATORIO CLINICO ESMERALDA INC
Provider Business Mailing Address
First Line : 207 AVE ESMERALDA
Second Line : PONCE DE LEON
City : GUAYNABO
State : PR
Zip : 00969-4448
Country : US
Telephone Number : 787-720-6943
Fax Number : 787-790-7060
Provider Business Practice Location Address
First Line : 207 AVE ESMERALDA
Second Line : PONCE DE LEON
City : GUAYNABO
State : PR
Zip : 00969-4448
Country : US
Telephone Number : 787-720-6943
Fax Number : 787-790-7060
Authorized Official
Title or Position : DIRECTOR
Name : MISS NELLY E ACEVEDO
Credential : M.T.
Telephone Number : 787-720-6943
Provider Enumeration Date : 01/11/2006
Last Update Date : 12/10/2007

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